I have a longstanding interest in cardiovascular research, and I have been involved in basic science, translational, and clinical projects. I am applying for this Career Development Award (CDA) in an effort to acquire additional training so that I can independently design and conduct meaningful clinical research. A key short-term goal of mine is to use the skills obtained from my proposed training program to develop collaborative research efforts both within and outside my institution. I have found it enjoyable to work with other researchers as I find such collaborations stimulate new research ideas and provide for additional learning opportunities. In the nearterm I also hope to increase my research productivity and writing skills by working with my mentor and his research group. My long-term goals are to become a leader in clinical research for my Department and use those skills to build productive research relationships between Emergency Departments (ED) in my region and to be able to mentor others interested in research careers. I believe that Emergency Medicine provides a wealth of potential research opportunities but lacks experienced leaders and mentors that can develop and guide clinical research proposals. The career development plan I am proposing is multifaceted. At the core is obtaining didactic training in the UMass Medical School Masters in Clinical Investigation Program. This program is directed by my mentor and focuses on coursework that is tailored specifically to provide students with the tools they need to become independent investigators. The courses cover clinical epidemiology, biostatistics, biomedical informatics, ethics, and the design and conduct of clinical research. My growth as a clinical researcher will also depend on the guidance of my mentor, co-mentor, and advisors. Dr. Robert Goldberg will serve as my primary mentor, and Dr. Theo Meyer as a co-mentor. Dr's. Goldberg and Meyer complement each other with regards to the expertise they bring to this proposal. Dr. Goldberg provides particular expertise with regards to study design, cardiovascular epidemiology, grant writing and manuscript preparation, and has a long track-record of obtaining NIH funding. Dr. Meyer is a practicing cardiologist with substantial expertise in the clinical management of heart failure (HF) as well as HF research. The primary aim of this proposal focuses on studying the effect that the timing of pharmacologic treatment for Acute Decompensated Heart Failure (ADHF) in the ED has on short term outcomes. I believe this is an important question not just because uncertainty exists with regards to how best to treat ADHF, but also because the quality of care provided is likely impacted by this uncertainty. The outcomes I am interested in are all related to the index hospitalization and include such things as the type of admission (ICU vs. floor), length of stay, and improvement in symptoms over 24 hours (via Visual Analog Scale Scores). These aims will be addressed both by collecting multicenter retrospective data and through prospective enrollment of ADHF patients in the ED. This approach will allow me to address my aims in multiple ED settings including teaching and community hospitals. Project Narrative: Approximately 5.3 million Americans presently suffer from heart failure (HF) and upwards of 700,000 new cases occur annually in the United States. Moreover, three-quarters of all Hospitalizations related to Acute Decompensated Heart Failure (ADHF) are initially seen in the Emergency Department (ED). Difficulties in making an accurate diagnosis, coupled with undefined acute treatment goals, make caring for high-risk ADHF patients in the ED a challenge. The significant morbidity and associated hospital and outpatient costs related to HF are estimated to exceed 30 billion dollars annually. Given this burden that HF places on the healthcare system, it has been recommended that more studies be done to investigate how to provide efficient care to these patients. Should more resources be directed at the care of ED patients with potential ADHF? How much do short-term outcomes such as length of stay and need for ICU care depend on the treatment decisions made in the ED? To address such questions, this study will attempt to gain insight into the initial ED care of ADHF in an attempt to understand what impact early treatment decisions have on clinical outcomes.